Clostridium difficile B 독소 유전자 직접검출법에 의한 항생제 연관 설사증과 위막성 대장염의 진단

홍유라,정석훈,김경보,이상호,최경현,박선자,박무인,전병찬 대한감염학회 2003 감염과 화학요법 Vol.35 No.5

목적 : Clostridium difficile은 항생제 연관 설사중(antibiotic-associated diarrhea, AAD)과 위막성 대장염(pseudo-membranous colitis, PMC)의 주요 원인균이다. 본 연구에서는 AAD나 PMC의 선행 인자를 조사하고, nested PCR에 의한 C. difficile B 독소 유전자 검출이 치료와 예후에 미치는 영향을 알아보고자 하였다. 대상 : 2002년 1월부터 동년 12월까지 독소 생성 C. difficile 검출이 의뢰된 고신대학교 복음병원 환자, 142예의 변 검체를 대상으로 하였다. Nested PCR법으로 C. difficile B 독소 유전자를 검출하였고 사용 항균제의 종류와 기간, 항암제 사용 유무, 임상증상, 치료 방법과 예후 등의 병력을 조사하였다. 결과 : 대상 환자 142예 중 56예가 C. difficile B 독소 유전자 양성이었다. AAD로 진단된 환자 113예 중 47예(41.6%) 및 PMC로 진단된 환자 8예 모두의 검체에서 C. difficile B 독서 유전자가 검출되었다. C. difficile B 독소 유전자 양성군의 92.7%에서 항균제 혹은 항암제 투여 중단과 경구 metronidazole 또는 vancomycin 투여법이 사용된 반면, 음성군에서는 48.5%에서만 이 치료법이 사용되었고 증상 호전율은 양성군이 82%로 음성군의 71%에 비해서 유의하게 높았다. 결론 : Nested PCR법을 이용한 C. difficile B 독소 유전자 검출법은 AAD나 PMC의 신속한 진단과 치료에 도움을 주어 호전율을 높이는데 기여함을 알 수 있었다. Background : Clostridium difficile is the major cause of antibiotic-associated diarrhea (AAD) and pseudomembranous colitis (PMC). This study was designed to investigate predisposing factors of AAD or PMC and to evaluate the efficiency of nested PCR assay for direct detection of toxin B gene in the treatment and prognosis of these diseases. Methods : From January to December, 2002, stool specimens from 142 patients in Kosin Medical Center, Busan, were tested for the detection of toxigenic C. difficile strains. Toxin B gene in C. difficile was detected by nested PCR. And chart review was performed to investigate the antibiotics or anticancer drug history, clinical symptoms, treatment regimens, and prognosis. Results : Among 142 stool specimens, 56 specimens showed positive for the toxin B gene in C. difficile strains by PCR. Forty two percents (47/113) of stool specimens from patients with AAD and all of specimens from eight patiens with PMC were C. difficile toxin B gene positive. Administration of antibiotics or anticancer drugs was stopped in 92.7% of toxin B gene-positive cases, but those were stopped in only 48.5% of toxin B gene-negative cases. The cure rate was higher in positive cases (82%) than negative ones (71%). Conclusion : It is concluded that nested PCR assay for the direct detection of C. difficile toxin B gene was helpful in rapid diagnosis and treatment of AAD or PMC.

초극소 저체중 출생아에서 회음부 궤양을 동반한 혈관종 치료경험 1례

홍유라 고신대학교 의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Hemangiomas represent the most common benign tumor of infancy, with ulceration its most frequent complication. I experienced a case who was extremely very low birth weight infant(born at 25 weeks gestation, 670 g) and had a ulcerated perineal hemangioma. Ulcerated hemangiomas in the perineal area are usually very painful and distressing for the infant and secondary infection is common. But no one uniformly effective treatment modality was found and their potential side effects in infant are not known. Without specific therapeutic modalities(corticosteroids, interferon alfa-2a and flashlamp pulsed-dye laser), I treated with local wound care(occlusive dressings) and management of infection. After 8 weeks of treatment, the ulcer was healed.

초극소 저체중 출생아에서 cytomegalovirus 패혈증 이후에 나타난 중추성 요붕증

홍유라 대한신생아학회 2012 Neonatal medicine Vol.19 No.3

I report a case of extremely low birth weight infant, who presented central diabetes insipidus associated with cytomegalovirus infection. His brain magnetic resonance imaging showed a flattened pituitary gland, and demonstrated a lack of posterior pituitary hyperintensity. It successfully managed with oral desmopressin (Minirin®) and persisted beyond the resolving of symptomatic cytomegalovirus infection. 저자는 초극소 저체중 출생아에서 거대세포 바이러스로 인한 패혈증과 동반된 중추성 요붕증을 vasopressin 투여 검사로 진단하였다. 뇌자기공명영상에서는 뇌하수체 후엽의 저신호강도와 편평화를확인하였다. 경구용 desmopressin 치료에 반응하여 소변량 감소와혈청 나트륨이 정상화되었다. gancyclovir 치료 후 거대세포 바이러스 감염으로 인한 증상이 호전된 후에도 중추성 요붕증은 지속되어52개월째 Minirin® 복용 중에 있다.

고용량 Ara-C를 기조로 한 소아 급성골수성백혈병 환아의 치료

홍유라,이보영,이정현,강지혜,박재선,김미향 고신대학교 의학부 2004 高神大學校 醫學部 論文集 Vol.19 No.1

목적: 급성골수성백혈병 환아들에 대한 치료성적을 향상시키기 위화여 단일기관에서 진료한 환아들의 임상적 특징, 치료 성적을 분석하였다. 방법 : 1991년 8월부터 2001년 9월까지 고신대학교 복음병원에서 치료받은 급성골수성백혈병 환아 16례의 말초혈액소견, 골수검사소견, 치료, 사인, 관해율과 생존율을 후향적으로 분석하였다. 결과 : 1. 급성골수성백혈병 소아 12례 중 8례에서 변형 Capizzi-Denver 항암요법(고용량 Ara-C, Adriamycin, L-asparaginase, Etoposide, Thioguanine, Dexamethasone)을, 4명에서는 "DCTER 항암요법" (Dexamethasone, Cytarabine, Thioguanine, Etoposide, Rubdomycin)으로 치료하였다. 2. 치료를 받았던 환아 12명 중 9명에서 관해되어 관해율은 75%(9/12)였으며 6년 무사고 생존율은 19%(3/16)이나 일단 관해된 환자에서 6년 이상 재발없이 관해를 유지했던 환자의 비율은 25%(n=12. 3 in CCR) 였다. 3. 변형 Cappizzi요법을 받았던 8명의 환아만을 대상으로 보면 관해율은 100%였으며 6년 무재발 생존율은 37.5%(3/8)였다. 4. 사망한 13례의 주된 사인은 치료 전 진행된 암에 의한 DIC 1례, 치료 전 뇌출혈 1례, 진단 즉시 치료거부 2명, 치료 중 종양용해증후군 1례, 카테타 심장삽관 중 심정지 1례, 치료 중 자의 중단 1례, 관해 후 재발 2례, 관해 후 패혈증 2례, 말초자가 조혈모세포이식 과정에서 수혈 후 폐부종 1례, 장염 1례였다. 결론 : 치료 초기부터 고용량 Ara-C를 사용하는 "변형 Capizzi-Denver요법"의 관해율, 치료독성은 기존 치료법들과 비슷한 수준이며, 생존 환자가 적어 치료 성적의 비교가 곤란하나 향후 더 많은 환자를 대상으로 한 연구가 요망된다. Purpose: To improve the survival of children with acute myelocytic leukemia(AML), retrospective evaluation of treatment results was made in a single institution. Methods: From August 1991 to September 2001, 16 children with AML diagnosed at Kosin University Collage of Medicine were analysed in terms of remission, survival and cause of death. Twelve of the 16 patients were applicable to an induction and postremission chemotherapy with "modified Capizzi-Denver regimen" (Cytarabine, Adriamycin, Dexamethasone, L-asparaginase, Etoposide, Thioguanine) or "DCTER regimen" (Dexamethasone. Cytarabine, Thioguanine, Etoposide, Rubdomyein) Results: 6-year event free survival by Kaplan Meier estimation was 19%. 9 of 12 treated patients responded to the induction therapy and the probability of remaining in first remission was 33%. All patients in "modified Capizzi-Denver regimen" remitted (8/8) and 3 of them have been survived more than 6 years. Conclusion: Although the number of patients was small, some of the patients with AML achieved long term survival with "modified Capizzi-Denver regimen without severe toxicity and need study with more patients.

CTX-M-9형 extended-spectrum β-lactamase 생성 Enterobacter cloacae의출현

홍유라,유호연,배일권,권수봉,정석훈,김현주,김윤화,이상희 대한임상미생물학회 2005 Annals of clinical microbiology Vol.8 No.1

Background: The aim of this study is to assess the prevalence and to investigate the molecular epidemiology of Ambler class A extended-spectrum β-lactamase (ESBL)-producing Enterobacter cloacaeisolates in a university hospital in Busan, Korea. Methods: Non-duplicated clinical isolates of E. cloacae from patients admitted in Kosin University Gospel Hospital were collected during the period from January through September, 2003. ESBL-production was examined by the double-disk synergy test (DDST) and the transferability of cefotaxime-resistance by conjugation. MICs of β-lactam antibiotics were determined by the agar dilution method and Ambler class A ESBL genes were searched by PCR amplification. Enterobacterial repetitive intergenic consensus (ERIC) PCR was performed to investigate epidemiological relationships among blaCTX-M-9 gene-carrying E. cloacaeisolates. Results: Antimicrobial resistance rates of E. cloacae isolates (n=148) to ceftazidime, cefotaxime, and aztreonam were 50.0%, 29.6%, and 48.0%, respectively. Among 50 E. cloacae isolates intermediate or resistant to more than one expanded-spectrum β-lactam agent, 41 (27.7%) showed positive results in DDST; of these 41 isolates, 1 was found to carry blaTEM-52 gene, 16 carried blaSHV-12 gene, 4 blaCTX-M-9 gene, and 19 both blaSHV-12 and blaCTX-M-9 genes. The 23 E. cloacae isolates carrying blaCTX-M-9 gene showed 9 different profiles by ERIC PCR. Conclusion: ESBL-producing E. cloacae was not uncommon in a university hospital in Busan, Korea. The commonest types of ESBLs produced by E. cloacaeisolates were SHV-12 and CTX-M-9. CTX-M-9 ESBL-producing E. cloacaeisolates showed diverse ERIC-PCR profiles, indicating that they were not originated from a common source.

Reliability and validity of free software for the analysis of locomotor activity in mice

홍유라,문은수 영남대학교 의과대학 2018 Yeungnam University Journal of Medicine Vol.35 No.1

Background: Kinovea software that tracking semi-automatically the motion in video screen has been used to study motion-related tasks in several studies. However, the validation of this software in open field test to assess locomotor activity have not been studied yet. Therefore, this study aimed to examine the reliability and validity of this software in analyzing locomotor activities. Methods: Thirty male Institute Cancer Research mice were subjected in this study. The results examined by this software and the classical method were compared. Test-retest reliability and inter-rater reliability were analyzed with Pearson's correlation coefficient and intraclass correlation coefficient (ICC). The validity of this software was analyzed with Pearson's correlation coefficient. Results: This software showed good test-retest reliability (ICC=0.997, 95% confidence interval [CI]=0.975- 0.994, p<0.001). This software also showed good inter-rater reliability (ICC=0.987, 95% CI=0.973-0.994, p<0.001). Furthermore, in three analyses for the validity of this software, there were significant correlations between two methods (Pearson's correlation coefficient=0.928-0.972, p<0.001). In addition, this software showed good reliability and validity in the analysis locomotor activity according to time interval. Conclusion: This study showed that this software in analyzing drug-induced locomotor activity has good reliability and validity. This software can be effectively used in animal study using the analysis of locomotor activity.

초극소 저체중 출생아에서 발생한 기관 삽관 후 기관지 천공

홍유라 대한신생아학회 2012 Neonatal medicine Vol.19 No.3

Bronchial injury is a rare and serious complication of endotracheal intubation in neonates. Bronchial perforation following tracheal intubation causes a high-volume air leak mimicking pneumothorax and pneumomediastinum, and it may result in intraventricular hemorrhage, mediastinitis and sepsis. I report my experience of diagnosing a main bronchial perforation in an extremely low birth weight infant, who had a high-volume air leak following tracheal intubation, which persisted after chest tube insertion. 신생아에서 기관 삽관과 관련된 기관지 손상은 드문 합병증이다. 기관 삽관 후 발생한 기관지 천공은 기흉, 기종격 등 대량의 흉곽내공기 유출을 일으켜 뇌실내 출혈과 종격동염으로 인한 패혈증을 유발하며 높은 사망률을 보인다. 저자는 초극소저체중 출생아에서 기관 삽관 후 발생하였고 흉관 삽입 후에도 지속된 대량의 흉곽내 공기 유출을 수술을 통해 기관지 천공으로 진단하였기에 경험을 보고한다.

피부 백혈병을 동반한 선천성 급성 골수성 백혈병 1례

홍유라,김미향 고신대학교의과대학 2007 고신대학교 의과대학 학술지 Vol.22 No.2

Congenital leukemia is a rare disease developing within the first 4 to 6 weeks of life. Specific cutaneous leukemic infiltrates occur in 25% to 30% of infants with congenital leukemia and usually appear as firm blue, red, or purple nodules in a generalized distribution. We report a male term leukemic patient who presented with multiple skin nodules of reddish to purple color on the trunk and extremities. Skin biopsy revealed hematopoietic cells and acute monoblastic leukemia(M5 in FAB) was diagnosed by subsequent bone marrow aspiration. The skin lesion was completely disappeared after one cycle of chemotherapy with cytarabine, daunorubicin, etoposide, and dexamethasone, while the fraction of blasts remain unchanged.

Clostridium difficile B 독소 유전자 직접검출법에 의한 항생제 연관 설사증과 위막성 대장염의 진단

홍유라,정석훈,김경보,이상호,최경현,박선자,박무인,전병찬 대한감염학회 2003 Infection and Chemotherapy Vol.35 No.5

고용량 Ara-C를 기초로 한 소아 급성골수성백혈병 환아의 치료

홍유라,이보영,이정현,강지혜,박재선,김미향 고신대학교(의대) 고신대학교 의과대학 학술지 2004 고신대학교 의과대학 학술지 Vol.19 No.1

Purpose : To improve the survival of children with acute myelocytic leukemia (AML), retrospective evaluation of treatment results was made in a single institution. Methods : From August 1991 to September 2001, 16 children with AML diagnosed at Kosin University College of Medicine were analysed in terms of remission, survival and cause of death. Twelve of the 16 patients were applicable to an induction and postremission chemotherapy with "modified Capizzi-Denver regimen" (Cytarabine, Adriamycin, Dexamethasone, L-asparaginase, Etoposie, Thioguanine) or "DCTER regimen" (Dexamethasone, Cytarabine, Thioguanine, Etoposide, Rubdomycin). Results : 6-year event free survival by Kaplan Mejer estimation was 19%. 9 of 12 treated patients responded to the induction therapy and the probability of remaining in first remission was 33%. All patients in "modified Capizzi-Denver regimen" remitted (8/8) and 3 of them have been survived more than 6 years. Conclusion : Although the number of patients was small, some of the patients with AML achieved long term survival with "modified Capizzi-Denver regimen" without severe toxicity and need study with more patients.